IHSTeCA MEMBERSHIP FORM
District: For the Year: * One Calendar Year (Jan-Jan)
Last Name: Home Phone:
First Name: Home Fax:
Home E-Mail:
Home Address:
Home City:
Home Zip:
Are you a Teacher? Yes or No: If No, what is your occupation
Name of Business you are employed at or own:
Work Address: Work Phone:
High School Coaching At: School Phone:
School Address:
School City: School Zip:
School E-Mail: School Fax:
If you are a Teacher, is it in the school you are coaching? Yes or No:
If No, what school do you teach in:
School Address: School Phone:
Coach of Boys? Yes or No: Head Coach? Yes or No: Asst Coach? Yes or No:
Years Coaching Boys: Record Coaching Boys:
Coach Boy's From: To:
Coach of Girls? Yes or No: Head Coach? Yes or No: Asst Coach? Yes or No:
Years Coaching Girls: Record Coaching Girls:
Coach Girl's From: To:
WINS: Boys 100 Wins- Year: Girls 100 Wins- Year:
Boys 200 Wins- Year: Girls 200 Wins- Year:
Boys 300 Wins- Year: Girls 300 Wins- Year:
COACH OF YEAR: Boys District- Year: Girls District- Year:
Boys State- Year: Girls State- Year:
Please complete the above information and send along with your check for $30.00 made out to IHSTeCA to: Don Wafer, IHSTeCA Secretary-Treasurer, 3208 E. Randal Drive, Muncie, IN 47303.